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Therapeutic advances in alopecia areata

Presented at the joint International Eczema Council and National Alopecia Areata Foundation Symposium, "Atopic Dermatitis and Alopecia Areata: Comparison and Contrast”, held during the 2019 Annual American Academy of Dermatology meeting in Washington, DC to explore the similarities and differences between these two common but complex skin diseases and the implications from bench to bedside.

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Therapeutic advances in alopecia areata

  1. 1. Therapeutic Advances in Alopecia Areata Brett King, MD, PhD Associate Professor of Dermatology Yale University School of Medicine
  2. 2. Disclosures • Off-label use of medications will be discussed • I have received honoraria and/or consulting fees from: Aclaris Therapeutics, Concert Pharmaceuticals, Dermavant Sciences, Eli Lilly, Pfizer • I am a clinical trial investigator for: Concert Pharmaceuticals, Eli Lilly, Pfizer • I am on a speaker bureau for: Pfizer, Regeneron, Sanofi Genzyme
  3. 3. Alopecia Areata: Treatment • Intralesional corticosteroids • Topical corticosteroids • Topical immunotherapy (e.g. diphenylcyclopropenone, squaric acid) • Topical minoxidil • Oral corticosteroids • Methotrexate • Cyclosporine * No reliably effective therapies, especially for severe disease Strazzulla LC, et al. Alopecia areata: An appraisal of new treatment approaches and overview of current therapies. J Am Acad Dermatol. 2018;78(1):15-24.
  4. 4. Baseline 2 months tofacitinib 5 mg BID 5 months tofa 10 + 5 mg daily 8 months tofa 10 + 5 mg daily
  5. 5. Ruxolitinib 20 mg BID Nat Med. 2014;20(9):1043-9.
  6. 6. Alopecia Areata: Pathogenesis Divito SJ, Kupper TS. Nat Med. 2014;20(9):989–90. Based on Xing L, et al. Nat Med. 2014;20(9):1043-9.
  7. 7. CytokineSignalingisMediated byJAK-STATPathway Janus kinase (JAK) family consists of JAK 1, JAK 2, JAK 3, and Tyrosine Kinase 2 Vitiligo cytokine: IFN-g JAK 1/2 AA cytokines: IL-15, IFN-g JAK 1/2/3 JAK inhibitorJAK inhibitor Damsky W, King BA. J Am Acad Dermatol. 2017;76(4):736-744. AD cytokines: IL-4, IL-13 JAK 1/3
  8. 8. JAmAcadDermatol. 2017;76(1):22-28. JAmAcad Dermatol. 2017;76(1):29-32. JAmAcadDermatol. 2019;80(2):568-9. Brittany G. Craiglow, MD, and Brett A. King, MD, PhD New Haven, Connecticut JAmAcad Dermatol. 2019;80(2):566-8. Lucy Y. Liu, MD, and Brett A. King, MD, PhD New Haven, Connecticut JAmAcad Dermatol. 2018;78(2):403-4.
  9. 9. JAKi in AA: Clinical Trials JAK INHIBITOR TARGET ROUTE OF ADMINISTRATION PHASE STATUS IDENTIFIER ATI-501 JAK1/3 oral 2 active, not recruiting NCT03594227 ATI-502 JAK1/3 topical 2 not yet recruiting NCT03759340 baricitinib JAK1/3 oral 2/3 recruiting NCT03570749 CTP-543 JAK1/2 oral 2b/3 not yet recruiting NCT03811912 PF-06651600 JAK3 oral 2b/3 recruiting NCT03732807
  10. 10. Other Therapeutic Possibilities? • Apremilast • Ustekinumab • Dupilumab • Fecal transplant
  11. 11. Other Therapeutic Possibilities : Apremilast
  12. 12. Other Therapeutic Possibilities: Ustekinumab
  13. 13. Other Therapeutic Possibilities: Dupilumab
  14. 14. Other Therapeutic Possibilities: Fecal Transplant
  15. 15. The Future of AA Treatment • JAK inhibitors • Apremilast • Ustekinumab • Dupilumab • Fecal transplant • Other?
  16. 16. Thank you

Presented at the joint International Eczema Council and National Alopecia Areata Foundation Symposium, "Atopic Dermatitis and Alopecia Areata: Comparison and Contrast”, held during the 2019 Annual American Academy of Dermatology meeting in Washington, DC to explore the similarities and differences between these two common but complex skin diseases and the implications from bench to bedside.

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